T Nation

One Step Forward, Two Steps Back

-age: 36
-height: 5’ 10
-waist: 32 inches
-weight: 165 lbs (about 15% bf)
-describe body and facial hair: light build. moderately hairy, beard grows fairly fast and thick.
-describe where you carry fat and how changed: lower abs and love handles mainly. Hasn’t changed and difficult to lose.
-health conditions: Gluten Sesitive (likely Celiac), Epididymitis about 4 months ago, Vasectomy 3 years ago.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: No hair loss or prostate drugs. About 10 grams of OTC hydrocortisone cream (1% so about 10mg cortisone) topically in the AM.
-describe diet: pretty good, gluten-free with limited processed foods or sugars. About 3,000-3,500 cals per day. I was low-carb Paleo for a while before. Tried intermittent fasting (16 hr fast each day) and felt good but stopped because it was harder for me to hit my target caloric intake.
-describe training: 2-3x per week when feeling good. Lately, don’t have the energy to go to the gym.
-testes ache, ever, with a fever?: Yes, low grade fever with epididymitis. Cleared up with anti-biotics. Recently had minor pain in the same testicle but it went away the next day.
-how have morning wood and nocturnal erections changed: infrequent and weak.

Symptoms:
-Fatigue: some days it is exhausting to do anything. Most days I feel tired (but manageable) with periods of more intense fatigue (usually around 6pm).
-Mood swings/Irritable
-Difficult to get out of bed in the morning. Don’t feel rested when I wake up.
-Libido has dropped off a lot but no ED or performance issues. Just not interested very much at all anymore.
-Anxiety: can pop up without reason. Lately it seems to be accompanied by constricted/dry nasal passages - feels like I not getting enough air.

  • Difficulty handling stress: A minor argument can be overwhelming and can ruin me for a couple of days. Major stress tends to focus me and I’m able to perform but once things calm down I crash. This has been confusing because I will feel better when under acute stress but worse when life is good and I’m trying to rest/recover.
  • Brain fog: lately it has been minor, worse in the past.
  • Hard time putting on muscle mass, and equally hard time losing belly fat.
  • Low average body temp (<98.0) and waking temp (<97.0)
  • Mild depression: mainly due to poor health and not getting better, not being able to workout.
  • Social withdraw. Don’t want to talk to people sometimes, even good friends.
  • Frequent illness (colds) that tend to linger for up to a month
  • Don’t feel hungry when I should. I usually have to force myself to eat a meal, especially breakfast. Will feel really hungry after a big dinner.
  • Prickly, tingly feeling in my shoulders, arms or legs at times. Moves around but usually balanced (left and right side feel the same). Not numbness. Kind of like really light electricity.

Current Supplements:
Gaia herbs Adrenal Support (2 caps 2x per day with meals)
Multivitamin (Vitamin Code Men)
Vit B stress complex
Vit D 6000 iu (I wasn’t very consistent with this leading up to the blood test - probably 2x per week)
Vit C 1000mg
Fish Oil - about 2g

History
I have been lifting off an on over the last 10 years with little to no progress. Two years ago I started to really focus on my training and get serious about my diet in an attempt to put on some weight. I made a little progress but it stalled - couldn’t gain weight and wasn’t leaning out either. Around that same time, I started having increased feelings of anxiety and frequent illnesses that kept me out of the gym for long periods of time.

Saw a Functional Medicine Dr. and was diagnosed with Adrenal Fatigue (via 24hr saliva test), hookworm, low Vit-D, and Gluten Sensitvity. Treated the hookworm, supplemented for Adrenal Fatigue (sublingual liquorice root, DHEA, and Pregneolone) and Vit-D, tried to reduce stress and improve sleep. Went 100% gluten free and did an elimination diet to rule out any other food reactions. Lost weight and leaned out but lost a lot of strength. Felt a little better, returned to the gym and built my strength back up. Each time I started to make progress, injury or illness would kill my gains.

In October, I went through a stressful time and wasn’t recovering well. Fatigue started to get much worse around December, to the point that I began wondering if I had Addisons. Adrenal Supplements and rest were not helping at all so I resorted to OTC Cortisone cream to help prop up my adrenals. After a couple weeks I started to feel better, back in the gym taking it easy, but after 3 weeks it all went downhill again. Fatigue came back even with Cortisone. Found a HRT Dr. that was listed as In-Network by my insurance and made and appt. Turns out he doesn’t take insurance anymore but I decided to do the blood work meet with at least once.

At this point I don’t care about gains in the gym. I just want to feel better.

Dr. ordered a bunch of test that may or may not be relevant, so I’m only going to list the highlights here and I’ll include the full report in a later post. Unfortunately, he did not include LH, FSH, Prolactin, or rT3. Also, I discontinued the topical cortisone four days prior to the test, as I didn’t want my adrenal labs to be artificially propped up.

Lab Results from 2/8/12 @ 8:15am (partial)

WBC: 4.33 K/uL (4.5-11.5)
MCH: 31.4 pg (27-31)
CO2: 37 mEq/L (21-31)
BUN: 22 mg/dL (7.0-25.0)
Creatinine: 1.0 mg/dL (0.7-1.2)
BUN/Creatinine Ratio: 22.0 (10.0-20.0)
Vitamin B-12: 890 pg/ml (211-911)
Vitamin D,25 Hydroxy: 36 ng/ml (>30)
Cortisol-AM: 20 ug/dL (8-23)
T3 Free: 3.00 pg/mL (2.3-4.2)
T3 Uptake: 34.7% (22.5-37.0)
T4 Free: 1.48 ng/dL (0.89-1.76)
TSH (ultrasensitive): 1.94 uIU/ml (0.34-4.00)
Thyroglobulin Autoabs: <20.0 IU/mL (<40)
Thyroid Peroxidase Autoabs: <10.0 IU/mL (<35)
IGF-1: 389.0 ng/mL (109-284)
Testosterone Total: 348.0 ng/dL (20-49 years: 160-726)
SHBG: 31.3 nmol/L (13-71)
Free Testosterone: 67 pg/ml (47-244)
Albumin: 4.9 g/dL (3.5-4.8)
DHEA-S: 265.0 ug/dL (80.0-560.0)
Estradiol: 20 pg/mL (0-39.8)
Progesterone: 0.49 ng/mL (0.28-1.22)
5-a-Dihydrotestosterone: 220.0 pg/ml (106.0-719.0)

To be honest, I don’t know how to feel about these results. Cortisol looks good, and Thyroid labs aren’t as bad as I expected based on my symptoms and body temps. Test is low but IGF-1 is high (WTF?). And I don’t know what the deal is with my WBC and CO2. I was hoping the labs would clarify things for me but now I’m even more confused. Am I missing something?

I meet with the Dr. tomorrow and would really appreciate any feedback you guys might have. Any thing else I should be considering before starting treatment?

Thanks!

What treatment are you considering starting? TRT? Then yes, you need at least LH/FSH and prolactin.

Thanks for the quick reply VTBalla. Honestly, I’m not sure where to go from here and I want to be prepared before my first appt. I expect the Dr will suggest TRT but I’m unsure if I should be looking to treat a thyroid issue first. I think my symptoms and body temps suggest hypothyroid but I’m not sure that my labs indicate that. My TSH is a little high and fT3 may be a little lower than optimal but is that enough to make me hypothyroid? How far outside of the optimal range do you have to get before you start having issues?

Thanks. I’ll definitely test for LH/FSH and prolactin before starting TRT. Is that mainly to determine primary or secondary hypogonadism?

There are very few doctors alive that will treat those thyroid levels…

Yes to your primary/secondary question.

Met with the Doc last week and it went pretty well. His main concerns were some vitamin deficiencies and low T. He put me on some new supplements and wanted to start me on a T cream. I told him I’m concerned with transfer to my wife and kids, so he offered injections. I think it would be 100mg per week (self administered) but not sure which ester yet. He was out of stock and it will take a week to get more which is fine with me because I wanted more time to think about it.

I asked about doing the LH/FSH and prolactin labs and he didn’t feel they are necessary. He said he wants to treat me using the anti-aging model instead of the traditional model. I take that to mean that he thinks I’m healthy in general but age has started to slow down my T production. It also probably means his treatment plan would not be changed by the results of those tests. That sounds great and all but I’d like to know the root cause of my problem if possible and I’d like to do it before starting a treatment that will make it harder to determine at a later date. When I pushed some more for the tests, he was cool about it and agreed. I went and got the tests done today. Should have the results in a couple days.

If it turns out that I’m secondary, are there lab values (E2?) that may indicate if I’m a good candidate for a HPTA restart or not?

Here’s my updated list of supplements:

  • New Multivitamin (includes 1000mcg of Iodine)
  • Vit B-12 (sublingual)
  • Probiotic
  • Homocystine support
  • CoQ10 50mg (ubiquinol)
  • Vit B Stress complex
  • Vit D (6000 iu) liquid
  • Vit C 1000mg
  • Fish Oil 2g
  • Melatonin (3g before bed)

I’ve dropped the Adrenal Support and OTC hydrocortisone. I haven’t noticed any significant difference in the way I feel since changing things up but it’s still early on.

My body temps are still pretty low so I’m going to supplement with more Iodine (12.5mg). I would have started last week but I can’t find any in the local stores.

Meant to post these earlier.
Here are the full lab results from 2/8/12 @ 8:15am (I only listed partial results in the first post)

WBC: 4.33 K/uL (4.5-11.5)
RBC: 5.13 M/uL (4.7-6.1)
Hemoglobin: 16.1 g/dL (14.0-18.0)
Hematocrit: 49.7 % (42-52)
MCV: 96.9 fL (81-99)
MCH: 31.4 pg (27-31)
MCHC 32.4 g/dL (32.0-36.0)
RDW: 12.5 % (11.0-16.0)
Platelet Count: 334 K/uL (130-400)
MPV: 8.8fL (7.2-11.1)
Neutrophils: 56.7 % (40-75)
Lymphocytes: 35.6 % (20-45)
Monocytes: 4.8 % (0-9)
Eosinophils: 2.2 % (0-7)
Basophils: 0.6 % 0.0-1.5)

Glucose: 90 mg/dL (60-99)
Sodium: 140 mmol/L (135-146)
Potassium: 4.7 mmol/L (3.5-5.3)
Chloride: 103 mmol/L (98-110)
CO2: 37 mEq/L (21-31)
BUN: 22 mg/dL (7.0-25.0)
Creatinine: 1.0 mg/dL (0.7-1.2)
BUN/Creatinine Ratio: 22.0 (10.0-20.0)
Calcium Total: 9.8 mg/dL (8.5-10.5)
eGFR: >60 mL/min (>=60)
AST (SGOT): 20 U/L (0-40)
ALT (SGPT): 26 U/L (0-50)
Lipo (a): 18.0 mg/dL (puts me between 50th and 75th percentile)
Insulin: 7.0 uU/mL (3.0-25.0)

Vitamin B-12: 890 pg/ml (211-911)
CRP: <0.1 mg/L (<3)
Homocysteine: 8.4 umol/L (5.0-13.0)
Vitamin D,25 Hydroxy: 36 ng/ml (>30)
Cortisol Total: 20 ug/dL (A.M. serum: 4.3-22.4)
Ferritin: 158 ng/mL (22-322)
Cortisol-AM: 20 ug/dL (8-23)

T3 Free: 3.00 pg/mL (2.3-4.2)
T3 Uptake: 34.7% (22.5-37.0)
T4 Free: 1.48 ng/dL (0.89-1.76)
TSH (ultrasensitive): 1.94 uIU/ml (0.34-4.00)
Thyroglobulin Autoabs: <20.0 IU/mL (<40)
Thyroid Peroxidase Autoabs: <10.0 IU/mL (<35)

IGF-1: 389.0 ng/mL (109-284)
Testosterone Total: 348.0 ng/dL (20-49 years: 160-726)
SHBG: 31.3 nmol/L (13-71)
Free Testosterone: 67 pg/ml (47-244)
% Free Testosterone: 1.92% (1.5-3.2)
Bioavailable Testosterone: 178 ng/dL (128-430)
Albumin: 4.9 g/dL (3.5-4.8)
DHEA-S: 265.0 ug/dL (80.0-560.0)
Estradiol: 20 pg/mL (0-39.8)
Progesterone: 0.49 ng/mL (0.28-1.22)
5-a-Dihydrotestosterone: 220.0 pg/ml (106.0-719.0)
Corticosteroid Binding Globulin (CBG):3.5 mg/dL (2.3-3.9)
IGF Binding Protein-3 (IGFBP-3): 3.1 mg/L (1.9-3.6)
Lp-Pla2: 173 ng/mL (<200)
Magnesium, RBC: 4.8 mg/dL (4.2-6.8)
Zinc, RBC: 1112 ug/dL (782-1502)

Got the results for the LH/FSH and prolactin labs

February 27, 2012
FSH: 6.4 mIU/ml (1.4-18.1)
LH: 4.5 mIU/mL (1.5-9.3)
Prolactin: 6.6 ng/mL (2.1-17.7)

So what does this mean? I could be wrong but they seem pretty normal, so now I’m unsure if I’m primary or secondary. And does it even matter? It doesn’t seem like a restart would work for me anyways.

Is it possible to have one testicle that is damaged and the other putting out just enough T to keep the pituitary from raising gonadotropin levels? Could some combination of primary and secondary result in normal numbers like this? Or is this just me getting older?

Any thoughts on this would be greatly appreciated!

Pituitary output looks fine. this indicates a degree of primary hypogonadism…the crappy thing is that your levels aren’t TOO low from an endo’s perspective, but as we all know they are not optimal…

If I were you, I would talk to my doctor about TRT…no need to try a restart–it is already started

I really appreciate the advice VTBalla.

My Dr had offered T injections already so I’m going to go that route. He didn’t say anything about HCG or AI though. Do I need to push for these at the beginning or can I start the T and see if my labs/symptoms warrant their addition?

Do not add AI and HCG in until confirmed need.

Will do. Thanks again.

Started 100mg per week test cypionate yesterday. I’m really hopeful that this helps. The brain fog and fatigue have been worse lately. I feel like a zombie most of the time.

Question:
Dr. gave me the full 100mg yesterday (Tues around noon). I want to do 2x per week injections - probably a Mon AM / Thurs PM schedule. Can I start that schedule with 50mg this Thursday evening or should I wait a little longer?

Yes to starting this Thursday–you will be fine. Most people that do AAS frontload their cycles the first week (taking nearly double their weekly dose in their first inject) to get them at their peak levels faster. Not as big of a concern on a perpetual TRT, but not a problem if you decide to do that.

I am older than you dude, and I’ve had problems with low testosterone… Androgel solved those problems for me.
I don’t mean this in any negative way but you seem like you could be suffering from depression. Are you prone to anxiety? I also got the sense that you are a bit of a hypochondriac, but acknowledge, that you have a right to feel good and be healthy. I admit I don’t know you and probably wrong to make these statements. One thing I want to know is how is your heart health? Again I am just speculating , that when I started to have problems I was in the midst of heart disease. I noticed that your in the normal range for the fasting glucose levels, which is good, but I don’t see any test results for your lipid levels. Again, don’t mean any harm to you, and hope you are doing well… Hope you see this and respond. Thanks

[quote]silee wrote:
I am older than you dude, and I’ve had problems with low testosterone… Androgel solved those problems for me.
I don’t mean this in any negative way but you seem like you could be suffering from depression. Are you prone to anxiety? I also got the sense that you are a bit of a hypochondriac, but acknowledge, that you have a right to feel good and be healthy. I admit I don’t know you and probably wrong to make these statements. One thing I want to know is how is your heart health? Again I am just speculating , that when I started to have problems I was in the midst of heart disease. I noticed that your in the normal range for the fasting glucose levels, which is good, but I don’t see any test results for your lipid levels. Again, don’t mean any harm to you, and hope you are doing well… Hope you see this and respond. Thanks[/quote]

I’ll take “Shitty things typical Endos say” for $100, Alex!

[quote]VTBalla34 wrote:

[quote]silee wrote:
I am older than you dude, and I’ve had problems with low testosterone… Androgel solved those problems for me.
I don’t mean this in any negative way but you seem like you could be suffering from depression. Are you prone to anxiety? I also got the sense that you are a bit of a hypochondriac, but acknowledge, that you have a right to feel good and be healthy. I admit I don’t know you and probably wrong to make these statements. One thing I want to know is how is your heart health? Again I am just speculating , that when I started to have problems I was in the midst of heart disease. I noticed that your in the normal range for the fasting glucose levels, which is good, but I don’t see any test results for your lipid levels. Again, don’t mean any harm to you, and hope you are doing well… Hope you see this and respond. Thanks[/quote]

I’ll take “Shitty things typical Endos say” for $100, Alex![/quote]

Not sure what an Endos is but this guy seemed concerned and his questions seemed pretty relevant. Id suggest answering these questions if your serious about getting better, mostly because you need to be honest with yourself and the people who are concerned enough to try to
help. You know what I mean big man.

[quote]silee wrote:
I am older than you dude, and I’ve had problems with low testosterone… Androgel solved those problems for me.
I don’t mean this in any negative way but you seem like you could be suffering from depression. Are you prone to anxiety? I also got the sense that you are a bit of a hypochondriac, but acknowledge, that you have a right to feel good and be healthy. I admit I don’t know you and probably wrong to make these statements. One thing I want to know is how is your heart health? Again I am just speculating , that when I started to have problems I was in the midst of heart disease. I noticed that your in the normal range for the fasting glucose levels, which is good, but I don’t see any test results for your lipid levels. Again, don’t mean any harm to you, and hope you are doing well… Hope you see this and respond. Thanks[/quote]

First, I appreciate your concern and interest even if I think your diagnosis is way off. I’m glad androgel has helped you. It is not an option for me because I will not risk transfer to my wife or kids.

Honestly, I’m not sure where you’re getting any of this. If you don’t think my labs warrant my current treatment, then say so.

I am not suffering from depression. My life is good. In terms of my mental and emotional state, my good days far FAR outnumber the occasional down day.

I am not a hypochondriac. I have been dealing with many of these symptoms for the last couple years and it has gotten worse over the last 6 months. Yes, I am interested in my health and fitness and I research those topics in my quest to better myself, but I started looking into adrenal fatigue, thyroid, and low T BECAUSE I felt like crap, not the other way around. I didn’t know TRT even existed until 2 months ago.

My lipids are fine. I don’t have the exact numbers in front of me but I know my total cholesterol is 200 and my HDL/LDL ratio is really good.

I am not self diagnosing, nor have I pushed any of my doctors for a certain diagnosis. I let the data speak for itself and then follow the treatment plan the Dr gives me. I like to be an informed patient, but that doesn’t make me a hypochondriac.

I acknowledge that there are a lot of guys on here whose labs look way worse than mine. I don’t know if they feel worse or the same as I do. I can only speak to how I feel and I don’t feel like myself, so I want to feel better. I think I deserve that - my family deserves that.

1 Like

[quote]okage wrote:
Not sure what an Endos is but this guy seemed concerned and his questions seemed pretty relevant. Id suggest answering these questions if your serious about getting better, mostly because you need to be honest with yourself and the people who are concerned enough to try to
help. You know what I mean big man.[/quote]

Endo = Endocrinologist.
From some of the stories I’ve read, they are not very helpful when it comes to TRT and (like most docs) would rather treat your symptoms with pharmaceuticals (like depression meds) than get to the root cause of the problem.

Thanks for your concern okage.

Go Niners! :slight_smile:

[quote]jl_blackfoot wrote:

[quote]okage wrote:
Not sure what an Endos is but this guy seemed concerned and his questions seemed pretty relevant. Id suggest answering these questions if your serious about getting better, mostly because you need to be honest with yourself and the people who are concerned enough to try to
help. You know what I mean big man.[/quote]

Endo = Endocrinologist.
From some of the stories I’ve read, they are not very helpful when it comes to TRT and (like most docs) would rather treat your symptoms with pharmaceuticals (like depression meds) than get to the root cause of the problem.

Thanks for your concern okage.

Go Niners! :)[/quote]

Good man, I always say that the best way to do something is mind, body and soul. Basically you gotta do your research, get the help, think about it positively, get advice from others going through the same shit, and do more research and more positive thinking. You know you can accomplish anything you set your mind to type shit!! Haha

On the other hand I dont have much experience other than the usual one step forward two steps back syndrome… except mines like the whole 3 steps forward 3 steps back… Im a fucking extremist like that. I love it and hate it I guess. Im working on it. I hope to one day be a 2 forward 1 back guy one day :wink:

Go Niners, good luck, I wish i could help more but I cant, but ill check in to hear about your progress and give as much support an motivation as I can !! cause that can only be good.

PS Go niners and SF giants, Baseballs starting eh.

Ps. Im known to ramble so dont mind me